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Fri, 24 Jul 2015 11:32:21 +0000en-UShourly1http://wordpress.org/?v=4.0Chiropractic Denial Managementhttp://www.acomhealth.com/chiropractic-denial-management/
http://www.acomhealth.com/chiropractic-denial-management/#commentsMon, 20 Jul 2015 11:20:37 +0000http://www.acomhealth.com/?p=5107Appealing denied claims is a frustrating and time-consuming process for even the most experienced billing department. There are many reasons a claim is denied and just as many ways to address the denial. I will give you a roadmap to navigate the denial management jungle. First identify the source of the denial. The most simple and often used method is ...

]]>Appealing denied claims is a frustrating and time-consuming process for even the most experienced billing department. There are many reasons a claim is denied and just as many ways to address the denial. I will give you a roadmap to navigate the denial management jungle.

First identify the source of the denial. The most simple and often used method is to check the EOB provided by the payer. All EOB’s have remark and reason codes detailing the denial. For example CO-97 tells us “The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.” You will find detailed and constantly updated listings of all the remark and reason codes at http://www.wpc-edi.com/reference/ . If you are still unclear on the denial reason after looking up the code you should pick up the phone and ask the payer for a better description.

BONUS TIP: Not all EOB’s with zero payment are denials! You may receive EOB’s with zero payment because the entire allowed amount is patient responsibility.

After you know why the payer is denying the claim it’s time to put your detective hat on and investigate. Take a look at your original claim and ask yourself the following questions.

• Is there anything that jumps out as an error the office made on the original claim? Perhaps a missing modifier or invalid diagnosis code?
• Are there any payer specific rules that were not followed?
• Does your contract specify that you have to bundle this procedure with another?

The previous questions will assist you in the next step. Let’s say that this particular claim that was denied using the CO-97 reason code was missing a 59 modifier on the secondary CPT code. Now how do we make that correction and get paid?

There are many different ways to get this claim corrected and paid. Each payer has their own protocols on how to address denials, they even call the process by different names to further cloud the issue. For example, Medicare had a clerical correction/addition/deletion phone line if you just need to add a modifier, but they also have reconsiderations and redeterminations. Some payers have specific forms to use. Others just want an “appeal letter”.

BONUS TIP: Organize your denials by payer so you can address all your denials for each payer in a single phone call.

Depending on the payer, you will either call, fax, mail or submit a reconsideration online. Depending on the appeal, you may or may not need to include supporting documentation, such as the original denial EOB, a new CMS1500 form and clinical records. A seasoned biller will know the ins and outs of each national and local payer’s appeal process. I recommend that every office keep and excel spreadsheet of these important guidelines for quick reference.

BONUS TIP: Appeal letters don’t vary all that much. Once you have a solid appeal letter for CO-97 written you shouldn’t have to start from scratch every time. Save all your appeal letters on a secure drive so you can reuse them by changing key information.

You have to follow up! Appeals take longer to process then the original claim, however payers are notorious for holding them longer then they should. If you haven’t gotten a response within 30 days pick up the phone.

By identifying the source of the denial, determining the course of action needed and following up in a timely manner you will keep on top of your denials.

]]>http://www.acomhealth.com/chiropractic-denial-management/feed/0When Patients Don’t Payhttp://www.acomhealth.com/patients-dont-pay/
http://www.acomhealth.com/patients-dont-pay/#commentsMon, 13 Jul 2015 23:46:11 +0000http://www.acomhealth.com/?p=5098Collecting money from patients is among the most difficult aspects of practice management, and an economic downturn will make the task even more challenging. The manner in which your office staff handles payment problems with patients reflects on your entire practice, and the outcome will have a significant effect on your staff’s satisfaction and your bottom line. Here are a ...

]]>Collecting money from patients is among the most difficult aspects of practice management, and an economic downturn will make the task even more challenging. The manner in which your office staff handles payment problems with patients reflects on your entire practice, and the outcome will have a significant effect on your staff’s satisfaction and your bottom line. Here are a few tips for helping your staff manage difficult situations.

Many patients do not understand that their insurance company’s reimbursement does not cover the full cost of care. Next time a patient says he doesn’t think he should have to pay you (“My insurance company pays you. Why do I have to pay too?”), it might help for you or your staff member to explain, for example, that the insurance company allows $42 for the service (despite the fact that your full fee is $50) and pays you $32 because the patient’s health insurance contract says he owes a $10 co-pay at each visit. Your staff must make it clear to patients who refuse to make their co-payments that they are actually in violation of their contract with their insurance company. Pointing this out may help patients better understand your role in the process.

Now that your staff has made it clear why the patient is responsible for paying, how can you help them collect from patients who say they can’t pay? You and your staff have probably heard these excuses a million times: “I don’t have my checkbook [or cash or a credit card]” or “I lost my checkbook.” My personal favorite is “My checkbook [or wallet, etc.] is in my car. I’ll be right back,” followed by the sound of tires screeching in the parking lot as your patient makes a getaway.

Some of these situations are impossible to deal with. For example, I do not recommend having a staff member run after a speeding car to collect a co-pay. One strategy that does work well is to give these patients pre-addressed, stamped envelopes and tell them to mail their co-pay to the office. Your staff may want to ask patients t to pay the co-pay before you treat them. If they have left their means of payment in their car, this will give them time to get it.

Your practice should accept credit cards. Credit cards have proven to be an important tool for collecting patient payments. Most patients have them, and they don’t have to be present to use them. For example, when a patient forgets to bring his wallet, checkbook and credit card to the visit, he can simply call you from home with a credit card number. It’s convenient for the patient, and it benefits the practice.
Patients who are angry and aggressive toward you or your staff are really fearful and insecure. They are afraid they won’t get what they need, so they confront you, guns blazing and tempers flaring, to get what they want. How can you help your staff handle them in a courteous, professional way while staying in control of their own emotions?

Train your staff to listen first. Let the irate patient get his or her story out and blow off steam. Only after the patient has said his or her piece is he or she likely to be open to anything your staff may suggest. Intervene too soon and the patient may become even angrier because of the interruption. Train your staff to take a deep breath, step back and listen, encouraging them to avoid the temptation to match the patient’s anger with their own.

Once the patient has calmed down, your staff member should assure the patient. The staff person should state “he or she is listening, is concerned about the patient’s problem and will do everything that he or she is reasonably able to do to help”. If the problem can not be resolved immediately, have your staff assure the patient that he or she will see the problem is addressed, and will notify the patient of the outcome.

Make sure your staff follows up with the patient. This is essential to keeping professional integrity – yours and your staff’s – intact. Trust is a big issue in medicine; both you and your staff need to show your patients that they can depend on your practice to help them.
To avoid future difficulties with patients, I recommend you inform patients in writing of all your policies and procedures (not just the financial ones), and ask the patients to read and sign that they will consent to them. Begin by including this in your admissions packet for new patients and make it a permanent part of each patient’s chart. If a patient wants services from your practice but refuses to sign your policies and procedures form, you may want to reevaluate that relationship. A patient that refuses to comply the basic rules of your practice will likely result in struggles down the road.

]]>http://www.acomhealth.com/patients-dont-pay/feed/0ICD-10 “Subluxation” Codes for Chiropractorshttp://www.acomhealth.com/icd-10-subluxation-codes/
http://www.acomhealth.com/icd-10-subluxation-codes/#commentsFri, 19 Jun 2015 15:01:00 +0000http://blog.acomhealth.com/?p=469For most chiropractors the “words” 739.1, 739.2, 739.3, 739.4, and 739.5 are regular vocabulary, however, in two years they will vanish! Why? Because they are ICD-9 codes, and ICD-9 is scheduled for execution on October 1st, 2015. ICD-10, incidentally, is also scheduled for execution on October 1st, 2015, bringing a whole new diagnosis vocabulary. Our beloved 739.x Nonallopathic lesions will become M99.01, M99.02, M99.03, M99.04, and M99.05 under ICD-10. These new ...

]]>For most chiropractors the “words” 739.1, 739.2, 739.3, 739.4, and 739.5 are regular vocabulary, however, in two years they will vanish! Why? Because they are ICD-9 codes, and ICD-9 is scheduled for execution on October 1st, 2015. ICD-10, incidentally, is also scheduled for execution on October 1st, 2015, bringing a whole new diagnosis vocabulary. Our beloved 739.xNonallopathic lesions will become M99.01, M99.02, M99.03, M99.04, and M99.05 under ICD-10. These new M99.0x codes are titled “Segmental and somatic dysfunction,” a bit more descriptive than “nonallopathic lesion” I’d say.

]]>http://www.acomhealth.com/icd-10-subluxation-codes/feed/0EMR for Chiropractic and Beyond- Privacy, Patient Consent, Patient Control??http://www.acomhealth.com/emr-privacy-patient-consent-patient-control/
http://www.acomhealth.com/emr-privacy-patient-consent-patient-control/#commentsFri, 19 Jun 2015 14:08:39 +0000http://blog.acomhealth.com/?p=122A unique situation is surfacing when it comes to Electronic Medical Records. You see, when medical records were in paper charts, physical custody was always the responsibility of the physicians office. Now in the age of technology, specifically interoperability, the location of ones medical record is no longer tied to a physical location. Herein lies the issue; should medical records now belong to patients? ...

]]>A unique situation is surfacing when it comes to Electronic Medical Records. You see, when medical records were in paper charts, physical custody was always the responsibility of the physicians office. Now in the age of technology, specifically interoperability, the location of ones medical record is no longer tied to a physical location. Herein lies the issue; should medical records now belong to patients? Meaning, should the patient have access to their own record at all times, and even control it? Take 3 minutes to read a summary of the HIT Policy Committee meeting on the topic – interesting arguments.

]]>http://www.acomhealth.com/emr-privacy-patient-consent-patient-control/feed/0Get Involved and Help Save Chiropractichttp://www.acomhealth.com/save-chiropractic-now-more-than-ever/
http://www.acomhealth.com/save-chiropractic-now-more-than-ever/#commentsSun, 14 Jun 2015 17:09:28 +0000http://blog.acomhealth.com/?p=44With all the changes taking place in the medial and healthcare industries these days, chiropractors can not sit idly by. The Foundation for Chiropractic Progress is a not-for-profit organization committed to the progress of the Chiropractic practice and helping to increase awareness about this extremely effective form of treatment though marketing, media, press etc. View the Foundation for Chiropractic Progress ...

]]>With all the changes taking place in the medial and healthcare industries these days, chiropractors can not sit idly by. The Foundation for Chiropractic Progress is a not-for-profit organization committed to the progress of the Chiropractic practice and helping to increase awareness about this extremely effective form of treatment though marketing, media, press etc. View the Foundation for Chiropractic Progress website to learn more about their very important mission and how you can help secure your own future.

]]>From April 27 through May 1, 2015, Medicare Fee-For-Service (FFS) health care providers, clearinghouses, and billing agencies participated in a second successful ICD-10 end-to-end testing week with the Centers for Medicare and Medicaid Services (CMS). This second end-to-end testing week demonstrated that CMS systems are ready to accept ICD-10 claims. Approximately 875 providers and billing companies participated, and testers submitted over 23,000 test claims. View the results.

The acceptance rate for April was higher than January tests, with an increase in test claims submitted and a decrease in the percentage of errors related to diagnosis codes. 23,138 test claims were submitted and 20,306 were accepted resulting in an 88% acceptance rate. Most of the claim rejections that occurred were due to errors unrelated to ICD-9 or ICD-10. These results demonstrate that CMS systems are ready to accept ICD-10 claims.

We urge you to prepare now for ICD-10 implementation. Medicare claims with a date of service on or after October 1, 2015, will be rejected if they do not contain a valid ICD-10 code. We expect all payers to follow the same procedures. You still have time to get ready. We have created a number of educational programs and training tools to help you get there. Visit our ICD-10 Section at www.acomhealth.com/icd10.

]]>http://www.acomhealth.com/second-round-icd-10-testing-successful/feed/0Myths and Facts of ICD-10 for Chiroshttp://www.acomhealth.com/myths-facts-icd-10/
http://www.acomhealth.com/myths-facts-icd-10/#commentsMon, 23 Mar 2015 16:52:34 +0000http://www.acomhealth.com/?p=43406 MYTHS AND FACTS OF ICD-10 The compliance date for ICD-10 implementation is October 1, 2015 for all HIPAA covered entities. The Department of Health and Human Resources (HHS) recently published an informative article titled “ICD-10-CM/PCS Myths and Facts” to help clarify ICD-10 ambiguity. Summarized highlights of that article follows below: Myth 1: ICD-10 implementation planning should be undertaken with ...

The compliance date for ICD-10 implementation is October 1, 2015 for all HIPAA covered entities. The Department of Health and Human Resources (HHS) recently published an informative article titled “ICD-10-CM/PCS Myths and Facts” to help clarify ICD-10 ambiguity. Summarized highlights of that article follows below:

Myth 1: ICD-10 implementation planning should be undertaken with the assumption that HHS will grant an extension beyond the October 1, 2015 compliance date.

Fact: All HIPAA covered entities must implement the new code sets with the dates of service or date of discharge for inpatients that occur on or after the compliance date. HHS has no plans to extend the compliance date for implementation; therefore, covered entities should plan to complete the steps required to implement ICD-10 on October 1, 2015.

Myth 2: Non-covered HIPAA entities, such as Workers’ Compensation and auto insurance companies that used ICD-9 may choose not to implement ICD-10

Fact: Because ICD-9 will no longer be maintained after ICD-10 is implemented, it is in non-covered entities’ best interest to use the new coding system. The increased detail in ICD-10 is of significant value to non-covered entities.

Myth 3: State Medicaid Programs will not be required to update their systems to ICD-10.

Fact: HIPAA requires the development on one official list of national medical code sets. The Centers for Medicare & Medicaid Services (CMS) will work with State Medicaid Programs to ensure ICD-10 is implemented on time.

Myth 4: No ICD-10 code books will be available. When ICD-10 is implemented, all coding will need to be performed electronically.

Fact: ICD-10 code books are already available and are a manageable size. The use of ICD-10 is not predicated on the use of electronic hardware and software.

Myth 5: ICD-10 based super bills will be too long or too complex to be of much use

Fact: Practices may continue to create super bills that contain the common Diagnosis Codes used in their practice. ICD-10 based super bills will not necessarily be longer or more complex. Neither ICD-9 nor ICD-10 super bills provide all possible code options for many conditions. The super bill conversion process includes:

Conducting a review that include removing rarely used codes

Crosswalking common codes from ICD-9 to ICD-10, which can be accomplished by looking up codes in the ICD-10 code book or using the General Equivalence Mappings (GEMs)

Myth 6: Current Procedure Terminology (CPT) will be replaced by ICD-10-PCS

Fact: ICD-10-PCS will only be used for facility reporting of hospital inpatient procedures and will not affect the current use of CPT.

For more information about ICD-10 visit our ICD-10 section of the website at acomhealth.com or the CMS ICD-10 section at www.cms.gov

]]>http://www.acomhealth.com/myths-facts-icd-10/feed/0Transition to ICD-10 for Chiroshttp://www.acomhealth.com/icd-10-implementation-for-chiros/
http://www.acomhealth.com/icd-10-implementation-for-chiros/#commentsMon, 23 Mar 2015 16:52:16 +0000http://www.acomhealth.com/?p=4343Five Simple Strategies for Making Short Work of a Tall Problem by Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC With the clock ticking on ICD-10 implementation, many practices are starting to worry they may not be ready in time for the Oct. 1, 2015 deadline. While there is much to accomplish in a short time frame, it can ...

by Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC
With the clock ticking on ICD-10 implementation, many practices are starting to worry they may not be ready in time for the Oct. 1, 2015 deadline. While there is much to accomplish in a short time frame, it can be done. Developing a solid strategy can help simplify the process and help you mitigate costs.

Engage with your vendors: If your vendors haven’t been in touch with you, you may have problems. Reach out to find out where they are in the implementation process and how it will affect you. Questions should include:

What offerings do they have for ICD-10?

How will updates be implemented?

How much will it cost?

When can you do testing?

What crosswalk solutions do they have?

Query the health plans you contract with: Questions should include:

Are any terms of my contract being changed?

What medical policies are changing?

What is the policy on handling of unspecified codes?

When can we test with you?

Educate your staff members: Everyone will need some level of training, and there are many free resources for training out there. Look for low-cost training through these avenues

Vendor user groups

Medical and specialty societies

Podcasts (such as Talk Ten Tuesdays on icd10monitor.com)

AAPC local chapters (there are more than 530 across the U.S.)

Health plans you contract wit

Beef up your documentation: Chances are, your medical records are not being documented with the highest level of specificity possible for patient encounters under current regulations. Starting now will not only prepare you for ICD-10, but it will also improve overall compliance. Start with these simple steps:

Run a practice management report of your most frequently utilized codes

Pull medical records that correspond with those diagnoses

Have coders review the records to see if a valid code can be assigned

Hold educational sessions to discuss improvements needed

Review your processes often: Make sure that the most important issues are being addressed, such as:

Is my vendor going to be ready on time?

Is my testing still producing positive results?

Are coder productivity levels increasing?

Is documentation compliant?

Are my health plans ready so that I can get paid?

It’s not too late to still get ready and make improvements. Waiting until closer to the implementation date will not only disrupt your strategy, but it will also have you diving deeper into your financial reserves to make sure you can be ready on time. Any time we have a new initiative there will be issues. But the only one who can prepare and protect your practice is you. Leaving it up to fate or hoping for another extension will wreak havoc on the ability of your practice to remain financially stable.

]]>http://www.acomhealth.com/icd-10-implementation-for-chiros/feed/0The Cost of Implementing ICD-10http://www.acomhealth.com/cost-implementing-icd-10/
http://www.acomhealth.com/cost-implementing-icd-10/#commentsMon, 23 Mar 2015 16:51:15 +0000http://www.acomhealth.com/?p=4337LATEST ICD-10 NEWS Despite ICD-10 having been delayed three times already by the federal government, industry analysts say healthcare officials should treat October 1, 2015, as the official set-in-stone kick off date. During the week of April 26 through May 1, 2015, a second sample group of providers will participate in ICD-10 testing with Medicare. Approximately 850 volunteer submitters nationwide ...

Despite ICD-10 having been delayed three times already by the federal government, industry analysts say healthcare officials should treat October 1, 2015, as the official set-in-stone kick off date. During the week of April 26 through May 1, 2015, a second sample group of providers will participate in ICD-10 testing with Medicare. Approximately 850 volunteer submitters nationwide will be selected to test. The goals is are to demonstrate that providers are able to successfully submit ICD-10 coded claims and, that CMS software, made to support ICD-10, will appropriately adjudicate claims and that accurate remittance advices are produced. This sample is expected to yield meaningful results. There will be another round of testing the week of July 20th.

THE COST OF IMPLEMENTING ICD-10

According to a cost study initiated by the American Medical Association (AMA), the implementation costs of the ICD-10 code set will be dramatically more expensive for most medical practices than previously estimated. According to the 2014 study, implementation costs can be three times higher than originally predicted. AMA’s cost study included training expense, practice assessments, testing, software upgrades costs, productivity loss and reimbursement disruptions. The following chart summarizes AMA’s estimated costs for a small medical practice and our estimate for Chiropractic practices.

ACOM Estimate Chiro Practices

Processes

AMA Estimate Med Practices

Training

$2,700-3,000

$600-2,000

Practice Assessment

$4,800-7,900

$0-5,000

Software Upgrades

$0-60,000

$0-15,000

ICD-10 Testing

$15,000-29,000

$0-5,000

Productivity Loss

$8,500-20,000

$5,000-10,000

Payment Disruption

$22,000-100,000

$15,000-80,000

Total

$56,000-226,000

$20,600-107,000

We do not anticipate Chiro practices spending as much on ICD-10 transition as medical practices for preparation activities like training, planning/assessment and testing, but Chiropractors do have the same financial exposure to productivity loss and payment disruption, which is by far the greatest cost of ICD-10 implementation if a practice is not prepared. CMS, for example, urges practices to have 3-4 months of income reserved for payment disruption. The better prepared practices will experience lower disruption in cash flow when ICD-10 goes into effect on October 1, 2015. The cost for software upgrades will depend on the extent of ICD-10 tool sets, modules and support incorporated into the upgrades. Some practices will have to acquire new software due to lack of ICD-10 capability and support from their current software vendor. Vendor readiness is so critical that our next article will cover how to determine if your vendors are adequately prepared for ICD-10.

]]>http://www.acomhealth.com/cost-implementing-icd-10/feed/0ICD-10 Explanation and ACOM Health’s Resourceshttp://www.acomhealth.com/icd-10-explanation-acoms-resources/
http://www.acomhealth.com/icd-10-explanation-acoms-resources/#commentsMon, 23 Mar 2015 16:50:33 +0000http://www.acomhealth.com/?p=4334A BRIEF EXPLANATION OF ICD-10 Right now, the U.S. health care system relies on a set of codes, referred to as ICD-9, to report diagnoses and in-patient procedures. Introduced in the US forty years ago, the ICD-9 code set will soon be replaced by the more detailed ICD-10, with a deadline for the transition of October 1, 2015. The United ...

Right now, the U.S. health care system relies on a set of codes, referred to as ICD-9, to report diagnoses and in-patient procedures. Introduced in the US forty years ago, the ICD-9 code set will soon be replaced by the more detailed ICD-10, with a deadline for the transition of October 1, 2015. The United States is behind most developed countries in implementing this improvement since over 20 other countries, including Australia, Canada, France, Germany and China, all currently use ICD-10 codes.

The ICD-10 code set is vastly expanded over ICD-9 and contains approximately 69,000 three-to-seven-digit alphanumeric codes, which is roughly five time the number of the current ICD-9 three-to-five digit codes. This expansion to alpha numeric enables a much higher level of detail than ICD-9 currently does. With ICD-10 physicians can make more informed treatment decisions, improve the accuracy of diagnosis codes and the efficiency of reimbursement. On the other hand, if a practice is not adequately prepared to implement ICD-10, reimbursements may be temporarily suspended or significantly delayed and cause painful cash flow disruptions. The transition from ICD-9 to ICD-10 is huge and it will be a monumental challenge to implement throughout the healthcare industry. Hospitals, medical practices, clearinghouses, software vendors and health insurance companies across the country are working hard to implement ICD-10 codes in time for the October 1st deadline.

Transitioning to ICD-10 is required by anyone covered by the Health Insurance Portability Accountability Act (HIPAA) which includes doctors, hospitals and health insurance companies, all of whom rely on these codes for diagnosing patients and billing for services. A smooth transition for a medical practice will require education, staff training and a well thought out implementation plan including a detailed timeline. If a medical practice or insurance payer doesn’t switch to ICD-10 by the deadline, claims cannot be processed.

ACOM Health’s Rapid Software System and its Billing/Claims Management service will be prepared to deliver ICD-10 coding and documentation well before the deadline. And during the transition we will be supporting you with education and support programs to help you prepare for this challenging transition. Read more about the support programs available to you in the following section.

In addition to this monthly newsletter, we have many more resources and programs that will be available between now and ICD-10 D-Day (October 1st) to help you prepare for the transition, which are summarized below:

ICD-10 Resource

Description

Availability (2015)

Monthly Newsletter

An informative letter emailed each month to help keep you abreast of ICD-10 news & events

Jan thru Oct

ACOM Health Website

A separate ICD-10 section on our website that will consist of informative ICD-10 articles, FAQ, videos and tools

Now and Ongoing

Monthly Webinar Series

Each month a webinar will be provided by an industry expert that will cover different aspects about planning, preparing and transitioning to ICD-10

Jan thru Sep

Video Education Series

A multi-part training video to help educate, guide and prepare you for ICD-10, which will include instruction on ICD-10 coding and documentation

Apr thru Sep

ICD Help Desk

Phone and email support for Q & A about ICD-10

Sep and Beyond

ICD-10 Coding Support

An on-demand ICD-10 coder will be available to connect to your Rapid System to do the coding, charge entry and claims submission on your behalf

Oct and Beyond

ICD-10 Virtual Biller

An on-demand ICD-10 biller will be available to connect to your Rapid System and manage the entire claims process including; the coding (described above), post EOB’s, claims collections and denial management and manage and update your AR.